Provider Demographics
NPI:1871113076
Name:KOMELASKY, ANNE KRISTIN (MA CAGS)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:KRISTIN
Last Name:KOMELASKY
Suffix:
Gender:F
Credentials:MA CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 OXFORDSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-6220
Mailing Address - Country:US
Mailing Address - Phone:703-855-4533
Mailing Address - Fax:
Practice Address - Street 1:701 OXFORDSHIRE LN
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-6220
Practice Address - Country:US
Practice Address - Phone:703-855-4533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-17
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool